Provider First Line Business Practice Location Address:
119 APPLEBEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78211-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-675-1576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2026